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21.
The subthalamic nucleus (STN) is a major target for treatment of advanced Parkinson's disease patients undergoing deep brain stimulation surgery. Microelectrode recording (MER) is used in many cases to identify the target nucleus. A real-time procedure for identifying the entry and exit points of the STN would improve the outcome of this targeting procedure. We used the normalized root mean square (NRMS) of a short (5 seconds) MER sampled signal and the estimated anatomical distance to target (EDT) as the basis for this procedure. Electrode tip location was defined intraoperatively by an expert neurophysiologist to be before, within, or after the STN. Data from 46 trajectories of 27 patients were used to calculate the Bayesian posterior probability of being in each of these locations, given RMS-EDT pair values. We tested our predictions on each trajectory using a bootstrapping technique, with the rest of the trajectories serving as a training set and found the error in predicting the STN entry to be (mean +/- SD) 0.18 +/- 0.84, and 0.50 +/- 0.59 mm for STN exit point, which yields a 0.30 +/- 0.28 mm deviation from the expert's target center. The simplicity and computational ease of RMS calculation, its spike sorting-independent nature and tolerance to electrode parameters of this Bayesian predictor, can lead directly to the development of a fully automated intraoperative physiological procedure for the refinement of imaging estimates of STN borders. 相似文献
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Laparoscopic feeding jejunostomy: also a simple technique 总被引:2,自引:1,他引:1
Michael H. Albrink James Foster Alexander S. Rosemurgy Larry C. Carey 《Surgical endoscopy》1992,6(5):259-260
Summary Placement of feeding tubes is a common procedure for general surgeons. While the advent of percutaneous endoscopic gastrostomy
has changed and improved surgical practice, this technique is contraindicated in many circumstances. In some patients placement
of feeding tubes in the stomach may be contraindicated due to the risks of aspiration, gastric paresis, or gastric dysmotility.
We describe a technique of laparoscopic jejunostomy tube placement which is easy and effective. It is noteworthy that this
method may be used in patients who have had previous abdominal operations, and it has the added advantage of a direct peritoneal
view of the viscera. We suggest that qualified laparoscopic surgeons learn the technique of laparoscopic jejunostomy. 相似文献
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Focal glomerulosclerosis in the remnant kidney model--an inflammatory disease mediated by cytokines 总被引:7,自引:0,他引:7
BACKGROUND: The mechanism of progression of established renal disease
remains unclear. While a low protein diet slows this progression, the role
of cytokines in this process has been little investigated. METHODS: We
investigated cytokine expression by Northern blot and immunohistochemistry
in two groups of 5/6 nephrectomized rats (5/6 Nx) fed a normal (24%) or low
(6%) protein diet and compared them with sham operated controls. RESULTS:
The rats on 6% protein diet had significantly less focal glomerulosclerosis
(FGS) (17.4 +/- 4.4 vs 27.4 +/- 8.8%, P < 0.05) and global sclerosis
(GGS) after 7 weeks (0.4 +/- 0.8 vs 3.5 +/- 2.1% of glomeruli P < 0.05).
Both experimental groups showed three times control levels of MCP-I
expression after 2 weeks. However in the 5/6 Nx 6% protein group the
expression decreased at 4 weeks (1.5 times controls) and reached control
levels after 7 weeks. In contrast, the 5/6 Nx 24% protein group exhibited a
further marked increase after 4 weeks (5.6 times controls) and was still
two-fold higher after 7 weeks. TGF-beta expression was modestly but
consistently increased at all time points (120-160% of controls), with no
difference between the two study groups. Neither IL-1 beta or TNF-alpha was
detectable at any time. Immunohistochemistry demonstrated TGF-beta
intracellularly in distal tubular cells in both experimental and control
animals, while MCP-1 protein was found in the area of FGS and in the apical
pole of distal tubular cells in both experimental groups. Glomerular and
interstitial ED1 positive cells were significantly increased after four
weeks in the 5/6 Nx 24% protein group (P < 0.05). CONCLUSIONS: A
'mechanical' injury to the kidney clearly results in an inflammatory
response associated with the upregulation of MCP-1. A low protein diet
modulates the expression of MCP-1 and improves the morphological sequelae
seen after renal ablation.
相似文献
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